Myelomeningocele: comprehensive treatment

The management of children born with myelomeningocele is now extended over an entire lifespan. Rehabilitation specialists managing these children must understand the initial anatomic dysfunction, its interaction with normal child development, and the effect of normal aging on pediatric-onset disabilities. A model for an interdisciplinary process that keeps the final goals of any child-onset disability in mind is discussed. A review of current medical, surgical, and behavioral interventions for these children is also presented.     

Low-efficiency of percutaneous adenovirus-mediated arterial gene transfer in the atherosclerotic rabbit.

Recombinant adenoviruses are the most efficient vectors with which to perform arterial gene transfer. Previous in vivo studies of adenovirus-mediated arterial transfection, however, have been performed using normal or endothelium-denuded arteries. It is unclear whether these results can be extended to atherosclerotic arteries. Accordingly, this study was designed to (a) assess the feasibility of adenovirus-mediated gene transfer to atherosclerotic lesions, and (b) compare the transfection efficiency, anatomic distribution of transfected cells, and duration of transgene expression achieved in normal versus atherosclerotic arteries. A recombinant adenovirus including a nuclear-targeted beta-galactosidase gene was percutaneously delivered to the iliac artery of normal (n = 25) and atherosclerotic (n = 25) rabbits. Transgene expression, assessed by morphometric as well as chemiluminescent analyses, was documented in all normal and atherosclerotic arteries between 3 and 14 d after gene transfer, but was undetectable at later time points. Transfected cells were identified as smooth muscle cells located in the media of normal arteries, and in the neointima and the vasa-vasora of atherosclerotic arteries. Two percent of medial cells, but only 0.2% of medial and neointimal cells expressed the transgene in normal and atherosclerotic arteries, respectively (P = 0.0001). Similarly, nuclear beta-galactosidase activity was higher in normal than in atherosclerotic arteries (3.2 vs. 0.8 mU/mg protein, P = 0.02). These findings indicate that atherosclerosis reduces the transfection efficiency which can be achieved with adenoviral vectors, and thus constitutes a potential limitation to adenovirus-based, arterial gene therapy.     

The effect of diabetes on B-type natriuretic peptide concentrations in patients with acute dyspnea: an analysis from the Breathing Not Properly Multinational Study

OBJECTIVE: Diabetes has been implicated in reduced myocardial compliance and changes in the intercellular matrix of the myocardium. We determined the effect of diabetes on B-type natriuretic peptide (BNP) concentrations in patients presenting to the emergency department with dyspnea. RESEARCH DESIGN AND METHODS: The Breathing Not Properly Multinational Study was a prospective evaluation of 1,586 patients. A subset of 922 patients was obtained and subdivided into the following groups: group 1 (n = 324), neither diabetes nor heart failure; group 2 (n = 107), diabetes and no heart failure; group 3 (n = 247), no diabetes and heart failure; group 4 (n = 183), both diabetes and heart failure; group 5 (n = 41), heart failure history with no diabetes; and group 6 (n = 20), heart failure history with diabetes. Patients from groups 1, 3, and 5 were matched to groups 2, 4, and 6, respectively, to have the same mean age, sex distribution, BMI, renal function, and New York Heart Association (NYHA) classification (for heart failure). RESULTS: There was no significant difference in median BNP levels between diabetes and no diabetes among no heart failure patients (32.4 vs.32.9 pg/ml), heart failure patients (587 vs. 494 pg/ml), and those with a heart failure history (180 vs. 120 pg/ml). Receiver-operating characteristic curve analysis of the area under the curve for BNP was not different in diabetic versus nondiabetic patients (0.888 vs. 0.878, respectively). However, in a multivariate model, diabetes was an independent predictor of a final diagnosis of heart failure (odds ratio 1.51, 95% CI 1.03-2.02; P < 0.05). CONCLUSIONS: History of diabetes does not impact BNP levels measured in patients with acute dyspnea in the emergency department. Despite the impact of diabetes on the cardiovascular system, diabetes does not appear to confound BNP levels in the emergency department diagnosis of heart failure.     

Quality of reporting internal and external validity data from randomized controlled trials evaluating stents for percutaneous coronary intervention

Background  

Stents are commonly used to treat patients with coronary artery disease. However, the quality of reporting internal and external validity data in published reports of randomised controlled trials (RCTs) of stents has never been assessed.     

Ethnic differences in the relationships of anthropometric measures to metabolic risk factors in Asian patients at risk of atherothrombosis : Results from the REduction of Atherothrombosis for Continued Health (REACH) Registry

The aim of the study is to examine the relationships between 4 anthropometric indices and metabolic risk factors (hypertension, atherogenic dyslipidemia, and glucose intolerance) in different Asian ethnic groups of patients at risk of atherothrombosis. We analyzed the baseline data of 11 017 Asian patients with established atherothrombotic cardiovascular diseases or at least 3 atherothrombotic risk factors. In East and South Asians, the graded relationships of body mass index (BMI) with the presence of at least 2 metabolic risk factors remained significant after adjustment for waist circumference (top vs bottom quartile—East Asians: odds ratio, 2.02; 95% confidence interval, 1.67-2.45; South Asians: 3.24, 1.18-8.95), whereas the graded relationships of waist circumference decreased or became nonsignificant after adjustment for BMI (East Asians: 1.64, 1.35-1.99; South Asians: 0.68, 0.20-2.30). In Southeast Asian men, the graded relationship of waist circumference with metabolic risk factors (2.27, 1.42-3.63) was stronger than that of BMI (1.34, 0.84-2.12), whereas in Southeast Asian women, there was a trend toward a stronger association between BMI and metabolic risk factors. In East Asians and in Southeast Asian women, the waist-to-BMI ratio decreased with the number of metabolic risk factors. The optimal cutoff points for BMI and waist circumference with regard to the presence of at least 2 metabolic risk factors were lowest in East Asians (men: 24 kg/m² and 86 cm; women: 24 kg/m² and 82 cm). Our findings suggest that both BMI and waist circumference, rather than waist circumference alone, should be included in metabolic risk assessment in this high-risk multiethnic Asian population. Uniform anthropometric cutoff values for all Asian ethnic groups are not appropriate to assess obesity-related metabolic complications, even in patients with established atherothrombotic disease.